Nursing shortage concerns

A recent report from the Kings Fund paints a worrying picture of the potential impact on patient care as a result of a fall in the number of nurses employed within the NHS. Nursing numbers are never stable – there is usually a rise in numbers in the autumn due to newly qualified nurses finding employment, with a fall in the summer months as staff resign or retire. However, an analysis of year-on-year nurse staffing numbers reveals a fall in full-time equivalent nursing numbers for the first time in over three years, and demonstrates that the number of nurses per 100,000 population has decreased from 604 in 2009, to 576 by 2016.

Following a period of rapid staff growth in the 2000s, in 2010 the government introduced a low, real-term growth, financial target upon the NHS in order to manage the UK’s budget deficit. This meant that, as staff pay accounts for 60-70% of a hospital’s budget costs, increasing the number of staff was no longer affordable once other costs were taken into consideration. QIPP (Quality, Improvement, Productivity and Prevention) programmes which were developed to improve efficiency, led to a reduction in the number of nurses employed in order to ensure financial and service delivery targets continued to be met.

In 2013 the publication of the Francis report into the care problems at Mid Staffordshire NHS Foundation Trust, raised the issue of safe nurse-staffing ratios which led Trusts to undergo nurse recruitment exercises which they would struggle to afford. The problem with recruiting more nurses, however, is not simply financial, there also needs to be a supply of available, trained, experienced nurses – which was not the case. From 2011 – 2013 the number of nurses leaving the profession was greater than the number joining (HEE Commissioning and Investment Plan), which left Trusts with staffing gaps which they could only fill by using expensive agency staff.

The recruitment of staff from the EU has helped to reduce some of the pressure, but already the impact of Brexit on recruitment from this area is being felt – with a 96% fall in the number of EU nurses joining the UK register since the referendum and new English Language requirements were introduced in 2016.

Given the time it takes to train a nurse, there are no immediate solutions in sight. The removal of bursaries for nurse training was aimed at increasing the number of places available by removing the financial restraint, however, it appears to have had the opposite effect with the number of successful applicants falling by 19% this year. In response to this, the Secretary of State has just announced that a further 5,000 nurse training places will be made available next year.

With winter pressures on the horizon, the availability of skilled, experienced, nurses is crucial to meeting the challenges facing all Trusts. Latest data shows a 0.7% increase in the nursing workforce when compared with the same point in 2010 – however, during this same timeframe there has been a 14% increase in emergency admissions.

Interestingly, the Government is adopting a different approach to the problem of GP shortages with plans to spend £100m to attract GPs from abroad. How successful this will be is difficult to predict, as the UK in no longer quite as attractive as it once was, particularly for clinical staff from EU countries.